Background China has one of the world's largest health insurance systems, composed of government-run basic health insurance and commercial health insurance. The basic health insurance has undergone system-wide reform in recent years. Meanwhile, there is also significant development in the commercial health insurance sector. A phone call survey was conducted in three major cities in China in July and August, 2011. The goal was to provide an updated description of the effect of health insurance on the population covered. Of special interest were insurance coverage, gross and out-of-pocket medical cost and coping strategies. Results Records on 5,097 households were collected. Analysis showed that smaller households, higher income, lower expense, presence of at least one inpatient treatment and living in rural areas were significantly associated with a lower overall coverage rate. In the separate analysis of basic and commercial health insurance, similar factors were found to have significant associations. Higher income, presence of chronic disease, presence of inpatient treatment, higher coverage rates and living in urban areas were significantly associated with higher gross medical cost. A similar set of factors were significantly associated with higher out-of-pocket cost. Households with lower income, inpatient treatment, higher commercial insurance coverage, and living in rural areas were significantly more likely to pursue coping strategies other than salary. Conclusions The surveyed cities and surrounding rural areas had socioeconomic status far above China's average. However, there was still a need to further improve coverage. Even for households with coverage, there was considerable out-of-pocket medical cost, particularly for households with inpatient treatments and/or chronic diseases. A small percentage of households were unable to self-finance out-of-pocket medical cost. Such observations suggest possible targets for further improving the health insurance system.
References
[1]
Wang T (2009) China takes a stab at universal healthcare. Accessed 2012 May 24th.
[2]
Blumenthal D, Hsiao W (2005) Privatization and its discontents – the evolving Chinese health care system. NEJM 353: 1165–1170.
[3]
Liu Y (2002) Reforming China's urban health insurance system. Health Policy 60: 133–150.
[4]
Jiang Q, Jiang Z, Zhao M, Tao J, Ling C, et al. (2011) Evaluation of a pilot cooperative medical scheme in rural China: impact on gender patterns of health care utilization and prescription practices. BMC Public Health 11: 50.
[5]
Sun X, Jackson S, Carmichael G, Sleigh AC (2009) Catastrophic medical payment and financial protection in rural China: evidence from the New Cooperative Medical Scheme in Shandong Province. Health Economics 18: 103–119.
[6]
You X, Kobayashi Y (2009) The new cooperative medical scheme in China. Health policy 91(1): 1–9.
[7]
Zhang L (2011) China's basic medical insurance system has covered more than 1.25 billion people. Network in China. Accessed 2012 May 24th.
[8]
Dong K (2009) Medical insurance system evolution in China. China Economic Review 20: 591–597.
[9]
Xu L, Wang Y, Collins CD, Tang S (2007) Urban health insurance reform and coverage in China using data from National health services surveys in 1998 and 2003. BMC Health Services Research 7: 37.
[10]
Lei X, Lin W (2009) The New Cooperative Medical Scheme in Rural China: Does More Coverage Mean More Service and Better Health? Health Economics 18: S25–S46.
[11]
Qiu P, Yang Y, Zhang J, Ma X (2011) Rural-to-urban migration and its implication for new cooperative medical scheme coverage and utilization in China. BMC Public Health 11: 520.
[12]
Wang H, Zhang L, Yip W, Hsiao W (2006) Adverse selection in a voluntary Rural Mutual Health Care health insurance scheme in China. Social Science & Medicine 63: 1236–1245.
[13]
Morrison J, Eggleston K (2008) Developing commercial health insurance in China. Field Note in Perspectives: China and the World. 10: 141–155.
[14]
Xinhua Net (2011) China's mainland population grows to 1.3397 billion in 2010: census data. Available at http://news.xinhuanet.com/english2010/ch？ina/2011-04/28/c_13849795.htm Accessed on 2012 May 24th.
[15]
Waksberg J (1978) Sampling methods for random digit dialing. Journal of the American Statistical Association 361: 40–46.
[16]
Nguyen KT, Khuat OTH, Ma S, Pham DC, Khuat GTH, et al. (2012) Coping with health care expenses among poor households in Dai Dong, a rural commune of Hanoi Vietnam. Social Science & Medicine 74: 724–733.
[17]
Zhang Y, Zhang X (2011) Assessing fund performance of China's basic medical insurance for urban employees: A model and an empirical test. 2011 International Conference on Social Science and Humanity. IPEDR 5: 356–358.
[18]
Ruger JP, Kim HJ (2007) Out of pocket healthcare spending by the poor and chronically ill in the Republic of Korea. American Journal of Public Health 97: 804–811.
[19]
You X, Kobayashi Y (2011) Determinants of out-of-pocket health expenditure in China: analysis using China Health and Nutrition Survey Data. Applied Health Economics and Health Policy 9: 39–49.
[20]
Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, et al. (2003) Household catastrophic health expenditure: a multicountry analysis. Lancet 362: 111–117.
[21]
Van Doorslaer EV, O’Donnell O, Rannan-Eliya RP, Somanathan A, Adhikari SR, et al. (2007) Catastrophic payments for health care in Asia. Health Economics 16: 1159–1184.
[22]
IBM website (2006) Healthcare in China: Toward greater access efficiency and quality. IBM Business Consulting Services. Accessed 2012 May 24th.
[23]
Wagstaff A, Lindelow M (2008) Can insurance increase financial risk? The curious case of health insurance in China. Journal of Health Economics 27(4): 990–1005.
[24]
Xiao S, Yan H, Shen Y, Dang S, Hemminki E, et al. (2010) Utilization of delivery care among rural women in China: does the health insurance make a difference? A cross-sectional study. BMC Public Health 10: 695.
[25]
Wagstaff A, Lindelow M, Gao J, Xu L, Qian JC (2009) Extending health insurance to the rural population: an impact evaluation of China's new cooperative medical scheme. Journal of Health Economics 28: 1–29.
[26]
Lu C, Chin B, Li G, Murray CJL (2009) Limitations of methods for measuring out of pocket and catastrophic private health expenditures. Bull World Health Organization 87: 238–244.
